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Pharmaceutical treatment patterns for patients with a diagnosis related to chronic pain initiating a slow-release strong opioid treatment in Sweden

Gustavsson, A.; Bjorkman, J.; Ljungcrantz, C.; Rhodin, A.; Rivano, Marcelo LU ; Sjolund, K. -F. and Mannheimer, C. (2012) In Pain 153(12). p.2325-2331
Abstract
Slow-release strong opioids (SRSO) are indicated in patients with severe chronic pain. Side effects, lack of efficacy and risk of dependency limit their use in clinical practice. The aim of this study was to explore prescription patterns of SRSO in Swedish real-world data on patients with a diagnosis related to chronic pain (DRCP). Patient-level data were extracted from the national prescriptions register and a regional register with diagnosis codes. The prescription sequences, switches, co-medications, and strengths over time were analyzed for cancer and noncancer patients. Of 840,000 patients with a DRCP, 16,257 initiated treatment with an SRSO in 2007 to 2008. They were 71 years old on average; 60% were female and 34% had cancer. The... (More)
Slow-release strong opioids (SRSO) are indicated in patients with severe chronic pain. Side effects, lack of efficacy and risk of dependency limit their use in clinical practice. The aim of this study was to explore prescription patterns of SRSO in Swedish real-world data on patients with a diagnosis related to chronic pain (DRCP). Patient-level data were extracted from the national prescriptions register and a regional register with diagnosis codes. The prescription sequences, switches, co-medications, and strengths over time were analyzed for cancer and noncancer patients. Of 840,000 patients with a DRCP, 16,257 initiated treatment with an SRSO in 2007 to 2008. They were 71 years old on average; 60% were female and 34% had cancer. The most common first prescription was oxycodone (54%) followed by fentanyl (19%), buprenorphine (14%), and morphine (13%). 63% refilled their prescription within 6 months, and 12% switched to another SRSO, most commonly fentanyl. After 3 years, 51% of cancer and 27% of noncancer patients still being in contact with health care remained on any SRSO. Of noncancer patients, 35% had a psychiatric co-medication (SSRI or benzodiazepine). In conclusion, fewer patients remain on SRSO in the long-term in clinical practice than reported in previous clinical trials. Oxycodone is the most common first SRSO prescription and one-third of patients get a prescription indicating psychiatric comorbidity. Our interpretation of these findings are that there is need for better treatment options for these patients, and that more effort is needed to improve treatment guidelines and to ascertain that these guidelines are followed. (c) 2012 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic pain, Opioid treatment, Pharmaceuticals, Oxycodone, Morphine, Fentanyl, Buprenorphine
in
Pain
volume
153
issue
12
pages
2325 - 2331
publisher
Elsevier
external identifiers
  • wos:000310772600007
  • scopus:84868545462
ISSN
1872-6623
DOI
10.1016/j.pain.2012.07.011
language
English
LU publication?
yes
id
fe98f27c-4d18-42fd-a6d6-6364dd2f775c (old id 3256275)
date added to LUP
2013-01-07 09:37:51
date last changed
2017-11-05 03:04:09
@article{fe98f27c-4d18-42fd-a6d6-6364dd2f775c,
  abstract     = {Slow-release strong opioids (SRSO) are indicated in patients with severe chronic pain. Side effects, lack of efficacy and risk of dependency limit their use in clinical practice. The aim of this study was to explore prescription patterns of SRSO in Swedish real-world data on patients with a diagnosis related to chronic pain (DRCP). Patient-level data were extracted from the national prescriptions register and a regional register with diagnosis codes. The prescription sequences, switches, co-medications, and strengths over time were analyzed for cancer and noncancer patients. Of 840,000 patients with a DRCP, 16,257 initiated treatment with an SRSO in 2007 to 2008. They were 71 years old on average; 60% were female and 34% had cancer. The most common first prescription was oxycodone (54%) followed by fentanyl (19%), buprenorphine (14%), and morphine (13%). 63% refilled their prescription within 6 months, and 12% switched to another SRSO, most commonly fentanyl. After 3 years, 51% of cancer and 27% of noncancer patients still being in contact with health care remained on any SRSO. Of noncancer patients, 35% had a psychiatric co-medication (SSRI or benzodiazepine). In conclusion, fewer patients remain on SRSO in the long-term in clinical practice than reported in previous clinical trials. Oxycodone is the most common first SRSO prescription and one-third of patients get a prescription indicating psychiatric comorbidity. Our interpretation of these findings are that there is need for better treatment options for these patients, and that more effort is needed to improve treatment guidelines and to ascertain that these guidelines are followed. (c) 2012 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.},
  author       = {Gustavsson, A. and Bjorkman, J. and Ljungcrantz, C. and Rhodin, A. and Rivano, Marcelo and Sjolund, K. -F. and Mannheimer, C.},
  issn         = {1872-6623},
  keyword      = {Chronic pain,Opioid treatment,Pharmaceuticals,Oxycodone,Morphine,Fentanyl,Buprenorphine},
  language     = {eng},
  number       = {12},
  pages        = {2325--2331},
  publisher    = {Elsevier},
  series       = {Pain},
  title        = {Pharmaceutical treatment patterns for patients with a diagnosis related to chronic pain initiating a slow-release strong opioid treatment in Sweden},
  url          = {http://dx.doi.org/10.1016/j.pain.2012.07.011},
  volume       = {153},
  year         = {2012},
}